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Division of Insurance Fraud Makes Four Arrests

The Florida Department of Financial Services’ Division of Insurance Fraud (DIF) made four arrests recently on allegations of three different insurance scams. As reported in the Insurance Journal, the alleged schemes involved personal injury protection (PIP) payouts and resulted in fraudulent insurance claims exceeding $145,000.

Staging an Accident Scene

One arrest reportedly involved the owner of a rehabilitation clinic. She allegedly staged a vehicle accident and paid each involved party $1,000 to seek unnecessary treatment at her clinic, along with another facility. She is accused of filing false medical insurance claims totaling about $63,000. Prosecutors charged her with insurance fraud, grand theft and organized scheme to defraud.

In an unrelated incident, an individual was arrested for his participation in a staged automobile accident. He is accused of visiting two clinics for unnecessary treatments following the false accidents. The services alleged services amounted to more than $70,000 in insurance claims. He was charged with insurance fraud and grand theft. The clinic owners and two employees were also arrested, with accusations that they participated in five separate staged accident schemes.

An Undercover Bust

The owner of a clinic, along with an employee, persuaded a patient to sign medical forms for treatments that were not rendered. The accused then allegedly paid the patient $1,000 and filed a claim on the false services, leading to a $11,000 recovery. The patient in the scenario was actually an undercover DIF agent posing as a patient, which resulted in the arrests. They are both charged with insurance fraud, grand theft and organized scheme to defraud.

The Statutes

Under Florida law, an individual commits insurance fraud when they:

  • Present a written or oral claim to an insurance policy that contains false or misleading information in regards to material facts;
  • Prepare a written or oral statement that contains false or misleading information in regards to material facts in connection with a claim;
  • Knowingly prepare or present false information in support of an application for insurance coverage; or
  • Knowingly prepare or present false information in relation to a claim for benefits with knowledge that that the payee submitted a false or fraudulent application when applying for a health care clinic licensure.

Violations of this statute range in severity from a third degree to a first degree felony. Potential punishments vary, depending on the amount of damages involved and the number of previous convictions. Additionally, convicted individuals can face hefty financial civil penalties.

The statute also contains a provision that prohibits involvement or organization of any planned motor vehicle accident scheme. Violations are classified as a second degree felony, with a minimum sentence of two years imprisonment.

If you are facing insurance fraud charges, a conviction could cost you your freedom, your livelihood and a substantial amount of money. DIF investigations are often lengthy and extremely detailed, so it is important that you secure the services of a knowledgeable lawyer as soon as you learn about the possibility of criminal charges.

If you or a loved one is facing insurance fraud charges, it is vitally important to contact a skilled lawyer in Miami. Call Ratzan & Faccidomo, LLC today at (305) 330-3905 for a confidential and free consultation.

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